CHICAGO—Including coronary CT angiography in one’s cardiology imaging study mix requires a thorough understanding of many things including potential turf issues, citing requirements, workflow, and reimbursement, said Ralph Gentry, RT, supervisor of cardiac MRI and cardiac CT. Gentry spoke on Thursday at the annual meeting of the Alliance of Cardiovascular Professionals (ACVP).
William Beaumont Hospital in Royal Oak, Mich., a 1061-bed teaching hospital, has eight CT scanners. One stands in the Heart and Vascular Center, the other seven belong to radiology.
The first thing to decide when buying a CT scanner for coronary CTA is which department will purchase it: radiology or cardiology. Will it be sited in radiology, in cardiology or in the emergency room?
Beaumont decided to combine cardiology, radiology, and vascular surgery in their Heart and Vascular Center.
Fortunately, the hospital was able to convert a pre-existing cath lab into a CT suite, and no construction was needed for patient prep rooms as well. Interventional radiology labs were relocated to the area, as well as vascular surgery suites. An MRI scanner also is within the same proximity.
“It’s truly a one-stop shop for the cardiovascular patient,” Gentry said.
Last year, about 2,500 CTA exams were performed in the Heart and Vascular Center, and about the same number of cardiac catheterizations, Gentry said.
Hospitals also need to consider the technologists who will be needed for CT exams. Beaumont employs five CT techs and three nurses, who came from the cath lab. Nurses perform the pre- and post-test patient assessment, and administer beta blockers. One clerical person helps with phone calls and patient flow.
Gentry said it’s important to educate the cath lab personnel and other physicians about CT technology and its importance to the process.
There were initial concerns that CTA would take work away from the lab. In reality, it has led to a decrease in diagnostic caths and an increase in interventional cath procedures.
The collaborative nature of cardiac CT imaging has allowed the cath lab to adopt the established CT suite policy in effect by radiologists.
Coronary CTA does not fill a complete schedule on a daily basis. At Beaumont, the scanner also is used to perform general CT studies, such as chest and abdomen. The scanners perform about 30 to 35 exams per day, with about 10 and 15 of them being CTAs.
Cardiologists read the coronaries, while radiologists overread the thorax. Fees are split. Cardiologists get the technical fee, radiologists get the professional fee.
Reimbursement for coronary CTA is in flux, but on March 12, the Centers for Medicare and Medicaid Services announced it would not enact a strict payment policy that would have allowed reimbursement only for patients enrolled in clinical trials.
A multi-societal effort to educate Congress as well as CMS officials about the value of coronary CTA is credited with helping sway CMS in favor of the new technology. Gentry recommends having schedulers call insurance companies to pre-qualify patients, making sure they are covered prior to their arrival for an appointment.
While radiation dose is a concern of many, technological advances and improved protocols have enabled exams to be given with an effective radiation dose as low as 3 to 5 mSv. That’s down from 12 to 15 mSv a few years ago.
The key to implementing a successful cardiac CTA program understanding how the technology will be managed, knowing the reimbursement policies in your area, and working collaboratively with multiple specialties to make the center attractive to the cardiovascular patient.